Danny Ruijters 17 April D-3D intra-interventional registration of coronary arteries

2 Outline Introduction 2D-3D Registration Results Measurements Future work Conclusions

2D-3D intra-interventional registration of coronary arteries 3 Introduction

2D-3D intra-interventional registration of coronary arteries 4 What is Coronary Artery Disease? Coronary Artery Disease (CAD) is a condition in which plaque builds up inside the coronary arteries. These arteries supply the heart muscle with oxygen-rich blood. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis. Source: National Heart Lung and Blood Institute,

2D-3D intra-interventional registration of coronary arteries 5 Diagnosis / treatment planning: Cardiac CT

2D-3D intra-interventional registration of coronary arteries 6 Treatment guidance: X-ray angiography Cathlab = Catherization Laboratory

2D-3D intra-interventional registration of coronary arteries 7 Cardiac CT & X-ray

2D-3D intra-interventional registration of coronary arteries 8 Coronary centerlines

2D-3D intra-interventional registration of coronary arteries 9 2D-3D Registration

2D-3D intra-interventional registration of coronary arteries 10 2D-3D Vessel Registration Intensity-based methods  - landmarks too small Iterative Closest Point  - segmentation not robust Conclusion: new method needed DRR X-ray

2D-3D intra-interventional registration of coronary arteries 11 Vesselness Filter

2D-3D intra-interventional registration of coronary arteries 12 Vesselness Filter Frangi et al.: Multiscale vessel enhancement filtering. MICCAI'98,

2D-3D intra-interventional registration of coronary arteries 13 Projection of the coronary centerlines

2D-3D intra-interventional registration of coronary arteries 14 Distance Transform

2D-3D intra-interventional registration of coronary arteries 15 Similarity Measure *

2D-3D intra-interventional registration of coronary arteries 16 Stochastic optimization Generation n best results produce m children

2D-3D intra-interventional registration of coronary arteries 17 Results

2D-3D intra-interventional registration of coronary arteries 18 Registration Stochastic Optimizer

2D-3D intra-interventional registration of coronary arteries 19 Registration Powell Optimizer

2D-3D intra-interventional registration of coronary arteries 20 Overlay visualization

2D-3D intra-interventional registration of coronary arteries 21 Measurements

2D-3D intra-interventional registration of coronary arteries 22 Measuring accuracy and capture range? Ground truth needed!!! → not possible for real world data. The perfect registration does not exist: –Cardiac motion –Respiratory motion –Patient pose Solution: use simulated data. Solution: use real world data, measure capture range by measuring translation and rotation of a successful registration. Objectivity, relevance to the clinical practice.

2D-3D intra-interventional registration of coronary arteries 23 Maximum capture range, using clinical data

2D-3D intra-interventional registration of coronary arteries 24 Simulate X-Ray, using cardiac CT

2D-3D intra-interventional registration of coronary arteries 25 Segmented CT

2D-3D intra-interventional registration of coronary arteries 26 Segmented forward projection

2D-3D intra-interventional registration of coronary arteries 27 Segmented forward projection

2D-3D intra-interventional registration of coronary arteries 28 Residual Error, using simulated data Same set of initial transformations (translation and rotation) was used for all methods.

2D-3D intra-interventional registration of coronary arteries 29 Future work

2D-3D intra-interventional registration of coronary arteries 30 Improving the similarity measure

2D-3D intra-interventional registration of coronary arteries 31 Tangent: Eigen vectors of the Hessian

2D-3D intra-interventional registration of coronary arteries 32 Multi-scale approach Start with coarse scales, and refine Gaussian blur the 2D image / vesselness image Use wider distance transform by increasing constant c 2 nd order derivative → Quasi-Newton optimization

2D-3D intra-interventional registration of coronary arteries 33 Conclusions

2D-3D intra-interventional registration of coronary arteries 34 Conclusions Clinical prototype installed in hospitals New York and Denver Very robust: accurate & large capture range Relatively fast: Powell 2.7 seconds, stochastic 11 seconds

Thank you!!!